Efficacy and safety of abaloparatide, denosumab, teriparatide, oral bisphosphonates, and intravenous bisphosphonates in the treatment of postmenopausal osteoporosis: a systematic review and Bayesian network meta-analysis.

BACKGROUND

Postmenopausal osteoporosis increases the risk of fractures, particularly in the lumbar spine, femoral neck, and total hip. Pharmacological interventions include anabolic agents (abaloparatide [ABA], teriparatide [TER]), antiresorptive agents (oral/intravenous bisphosphonates [OBP/IBP], denosumab [DEN]), and conventional therapy or placebo (PLA/CTRL). Evidence on their comparative efficacy and safety in postmenopausal women is limited.

METHODS

We conducted a Bayesian network meta-analysis of randomized controlled trials (RCTs) to evaluate the relative efficacy and safety of ABA, TER, OBP, IBP, DEN, and PLA/CTRL in postmenopausal women with osteoporosis. Primary outcomes included changes in lumbar spine, femoral neck, and total hip bone mineral density (BMD). Safety outcomes included all adverse events (AEs) and serious adverse events (SAEs). Data were synthesized using SUCRA rankings and network consistency was assessed via node-splitting and deviance information criteria (DIC).

RESULTS

Twenty-three RCTs comprising 80-7, 808 postmenopausal women were included. ABA demonstrated the greatest improvement in lumbar spine and femoral neck BMD, followed by TER, while ABA showed the highest effect on total hip BMD. IBP and DEN provided moderate benefits, superior to PLA/CTRL. TER and OBP had the lowest risk for AEs, and ABA and PLA/CTRL showed the lowest risk for SAEs. Overall, anabolic agents significantly improved BMD at the spine and femoral neck, whereas antiresorptive agents were more effective for hip BMD.

CONCLUSIONS

ABA and TER are most effective for improving spinal and femoral neck BMD in postmenopausal women, whereas ABA is superior for total hip BMD. Safety profiles were favorable for TER, OBP, and ABA. These findings provide evidence to guide individualized treatment selection based on fracture risk and high-risk skeletal sites in postmenopausal women.